What is in this leaflet
This leaflet answers some common questions about SIMVACOR. It does not contain all the available information.
It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking SIMVACOR against the benefits they expect it will have for you.
If you have any concerns about taking this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine.
You may need to read it again.
What is SIMVACOR used for
SIMVACOR helps to lower cholesterol and triglyceride levels.
SIMVACOR is used in people who have coronary heart disease (CHD) or who are at high risk of CHD (for example, if they have diabetes, a history of stroke or other blood vessel disease).
SIMVACOR may be used in these people, regardless of their cholesterol level to:
- help prolong life by reducing the risk of a heart attack
- reduce the risk of stroke
- reduce the need for surgery to increase blood flow to the heart
- reduce the need for hospitalisation due to angina
Everyone has cholesterol and triglycerides in their blood. They are types of blood fat needed by the body for many things, including building cell walls, making bile acids (which help to digest food) and certain hormones. However, too much cholesterol can be a problem.
Your body makes cholesterol, but it also comes from food. Normally the body balances the cholesterol it makes with the cholesterol it gets from food. This means if more cholesterol comes from food, less is made by the body. However, if you eat a diet high in fat, your body may not keep this balance and your cholesterol levels rise.
High cholesterol is more likely to occur with certain diseases or if you have a family history of high cholesterol. When you have high levels of cholesterol, it may 'stick' to the inside of your blood vessels instead of being carried to the parts of the body where it is needed.
Over time, this can form hard areas, called plaque, on the walls of blood vessels, making it more difficult for the blood to flow. This blocking of your blood vessels can lead to coronary heart disease (such as heart attack and angina) and stroke. In people with CHD, SIMVACOR may slow down the hardening of blood vessels and reduce the risk of developing new plaques.
There are different types of cholesterol, called LDL and HDL cholesterol. LDL cholesterol is the 'bad' cholesterol that can block your blood vessels. HDL cholesterol, on the other hand, is the 'good' cholesterol that is thought to remove the bad cholesterol from the blood vessels.
Triglycerides are an energy source for the body. However, as with cholesterol, too much triglycerides can be a problem.
How SIMVACOR works
SIMVACOR belongs to a group of medicines known as HMG-CoA reductase inhibitors. It works by reducing the amount of cholesterol made by the liver. In terms of good and bad cholesterol, SIMVACOR reduces the bad cholesterol and raises the good cholesterol.
SIMVACOR does not reduce the cholesterol and triglycerides that come from fat in food.
Therefore, when you are taking SIMVACOR, you also need to follow a low fat diet and other measures, such as exercise and weight control.
In most people, there are no symptoms of high cholesterol or triglycerides. Your doctor can measure your cholesterol and triglycerides with a simple blood test.
SIMVACOR is not recommended for use in children, as there have been no studies of its effects in children.
Your doctor may have prescribed SIMVACOR for another reason. Ask your doctor if you have any questions about why SIMVACOR has been prescribed for you.
SIMVACOR is not addictive.
Before you take SIMVACOR
When you must not take it
Do not take SIMVACOR if:
- you have an allergy to SIMVACOR, other brands of simvastatin, or any of the ingredients listed at the end of this leaflet. Symptoms of an allergic reaction may include skin rash, itchiness, shortness of breath, swelling of the tongue or face, or painful joints
- you are pregnant or breast-feeding. Your baby may absorb this medicine in the womb or from breast milk and therefore there is a possibility of harm to the baby
- you have liver disease
- you have had muscle pain, tenderness or weakness from other medicines used to treat high cholesterol or triglycerides
- the packaging is torn or shows signs of tampering
- the expiry date on the pack has passed. If you take this medicine after the expiry date has passed, it may not work.
If you are not sure whether you should start taking SIMVACOR, talk to your doctor.
Before you start to take it
Tell your doctor if:
- you intend to become pregnant or plan to breast-feed. SIMVACOR should not be used during pregnancy or while breast-feeding
- you have ever had liver disease. Your doctor will do a blood test to make sure you have no problems with your liver
- you have kidney disease or any other medical problems
- you have severe respiratory failure
- you drink alcohol regularly
- you have any allergies to any other medicines or any other substances, such as foods, preservatives or dyes.
If you have not told your doctor about any of the above, tell them before you take any SIMVACOR.
Taking other medicines
Tell your doctor if you are taking any other medicines, including medicines that you buy without a prescription from your pharmacy, supermarket or health food shop.
Some medicines should not be taken with SIMVACOR as they may increase the risk of muscle side effects with SIMVACOR. These include:
- nefazodone, used to treat depression
- protease inhibitors, used to treat HIV infection (including indinavir, nelfinavir, ritonavir, saquinavir) and Hep C infections
- erythromycin, telithromycin, clarithromycin and fusidic acid antibiotics used to treat infections
- ketoconazole, itraconazole, pasoconazole and variconazole used to treat certain fungal infections
If you are taking any of the above, your doctor may suggest stopping SIMVACOR temporarily or permanently.
Some medicines and SIMVACOR may interfere with each other. As taking SIMVACOR with any of the following medicines can increase the risk of muscle problems (see Side effects), it is particularly important to tell your doctor if you are taking:
- other medicines to lower cholesterol levels, for example, fibric acid derivatives (such as gemfibrozil) or nicotinic acid (also known as niacin)
- cyclosporin, used to suppress the immune system
- verapamil, diltiazem or amlodipine used to treat high blood pressure, angina or other heart conditions
- amiodarone, used to treat irregular heart beat
- medicines for preventing blood clots, eg. warfarin
- digoxin (a medicine used to control the rhythm of the heart)
It is also important to tell your doctor if you are taking anticoagulants (drugs that prevent blood clots) such as warfarin, nicotinic acid (also known as niacin) or fenofribrate, another fibric acid derivative.
Also tell your doctor if you are taking niacin or a niacin containing product and you are Chinese.
These medicines may be affected by SIMVACOR, may affect how well it works or may increase the risk of side effects with SIMVACOR. You may need different amounts of your medicine or you may need to take different medicines.
Your doctor or pharmacist has more information on medicines to be careful with or avoid while taking SIMVACOR.
How to take SIMVACOR
How much to take
Take SIMVACOR only when prescribed by your doctor.
Your doctor will tell you how many tablets you need to take each day. This depends on your cholesterol and triglyceride levels and other factors, such as kidney disease.
The recommended starting dose is 10 mg or 20 mg per day, taken in the evening, which may need to be increased up to 80 mg daily to have the best effect.
The 80 mg dose is only for patients who have not reached their cholesterol goal on the 40 mg dose.
People with CHD or risk factors for CHD are usually started on 40 mg per day, taken in the evening.
Swallow SIMVACOR with a glass of water.
Follow all directions given to you by your doctor and pharmacist carefully.
They may differ from the information contained in this leaflet.
If you do not understand the instructions, ask your doctor or pharmacist for help.
When to take it
Take SIMVACOR once a day in the evening.
The liver produces its greatest amount of cholesterol when the body is at rest and when there is no dietary intake. For most people, this is at night when asleep. Therefore, SIMVACOR is more effective when taken in the evening. A good time would be after your evening meal. However, it does not matter whether you take it before or after food.
Take SIMVACOR at about the same time each evening.
Taking your tablet(s) at the same time each evening will have the best effect. It will also help you remember when to take the tablets.
How long to take it
SIMVACOR helps lower your cholesterol. It does not cure your condition. Therefore, you must continue to take it as directed by your doctor if you expect to lower your cholesterol and keep it down. You may have to take cholesterol-lowering medicine for the rest of your life. If you stop taking SIMVACOR, your cholesterol levels may rise again.
If you forget to take it
If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember and then go back to taking your tablet(s) as you would normally.
If you are not sure whether to skip the dose, talk to your doctor or pharmacist.
Do not take a double dose to make up for the dose that you missed.
If you have trouble remembering to take your tablets, ask your pharmacist for some hints.
If you take too much (overdose)
Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26) or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else may have taken too much SIMVACOR. Do this even if there are no signs of discomfort or poisoning.
While you are taking SIMVACOR
Things you must do
If you become pregnant while you are taking SIMVACOR, stop taking it and contact your doctor immediately.
Have your blood fats checked when your doctor says, to make sure SIMVACOR is working.
If you are about to be started on any new medicine, tell your doctor and pharmacist that you are taking SIMVACOR.
If you are about to have elective surgery, tell your doctor that you are taking SIMVACOR.
Your doctor may suggest stopping the tablets a few days before surgery.
Things you must not do
Do not give SIMVACOR to anyone else, even if they have the same condition as you.
Things to be careful of
Avoid drinking large quantities of alcohol.
Drinking large quantities of alcohol may increase your chance of SIMVACOR causing liver problems.
Avoid drinking large quantities of grapefruit juice.
Grapefruit juice contains one or more components that alter the metabolism of some medicines, including SIMVACOR. Therefore, drinking very large quantities (over 1 litre) of grapefruit juice each day increases your chance of SIMVACOR causing side effects. These include aching muscles, muscle tenderness or weakness, not caused by exercise. However, one glass (250 mL) of grapefruit juice each day has not been shown to have any significant effect.
Be careful driving or operating machinery until you know how SIMVACOR affects you.
SIMVACOR generally does not cause any problems with your ability to drive a car or operate machinery. However, as with many other medicines, SIMVACOR may cause dizziness in some people. Make sure you know how you react to SIMVACOR before you drive a car or operate machinery.
Changes to lifestyle that may help reduce the chance of coronary heart disease
Lowering high cholesterol can help reduce your chances of having coronary heart disease (CHD). However, your chances of having CHD may be increased by several other factors including high blood pressure, cigarette smoking, diabetes, excess weight, family history of CHD, being a male and being a woman who has reached menopause.
Some self help measures suggested below may help your condition and help reduce your chances of having CHD. Talk to your doctor, pharmacist or dietician about these measures and for more information.
- Diet - continue the low fat diet recommended by your doctor, dietician or pharmacist.
- Weight - your doctor may advise you to lose weight if you are overweight.
- Exercise - make exercise a part of your routine - walking is good. Ask your doctor for advice before starting exercise.
- Smoking - your doctor may advise you to stop smoking or at least cut down.
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking SIMVACOR.
SIMVACOR helps most people with high cholesterol but it may have unwanted side effects in a few people.
All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor if you notice any of the following and they worry you:
- constipation, diarrhoea, wind
- stomach upset or pain, feeling sick (nausea)
These are the more common side effects of SIMVACOR. For the most part, these have been mild and short-lived.
Tell your doctor immediately if you notice any of the following:
- aching muscles, muscle tenderness or weakness, not caused by exercise
- brown/black coloured urine
On rare occasions, muscle problems can be serious, including muscle breakdown resulting in kidney damage.
The risk of muscle problems is greater for:
- patients taking higher doses of SIMVACOR
- older patients (65 years of age and older)
- female patients
- patients with abnormal kidney function
- patients with thyroid problems.
Tell your doctor immediately if you notice any of the following:
- tingling in the hands or feet
- yellowing of the skin and/or eyes, also called jaundice
- signs of anaemia, such as tiredness, being short of breath, and looking pale
- fever, generally feeling unwell
- skin rash, itchiness
- pinkish, itchy swellings on the skin, also called hives or nettlerash
- painful, swollen joints
- bruising more easily than normal
- larger breasts than normal in men
These may be serious side effects of SIMVACOR. Some of these may be symptoms of an allergic reaction to SIMVACOR. You may need urgent medical attention. Serious side effects are rare.
Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following:
- swelling of the face, lips, mouth, throat or tongue which may cause difficulty in swallowing or breathing
- shortness of breath
These are serious side effects. If you have them, you may have had a serious allergic reaction to SIMVACOR. You may need urgent medical attention or hospitalisation. Serious side effects are rare.
Also, tell your doctor if you notice:
- hair loss
- muscle cramps
- trouble sleeping
- poor memory
- sexual difficulties
- breathing problems including persistent cough and/or shortness of breath or fever
These are possible side effects of SIMVACOR.
Liver problems can also occur and may be serious. Your doctor will do blood tests to check your liver.
Other side effects not listed above may also occur in some patients. Tell your doctor if you notice any other effects.
Do not be alarmed by this list of possible side effects. You may not experience any of them.
After taking SIMVACOR
Keep your tablets in the blister pack until it is time to take them.
If you take the tablets out of the pack they may not keep well.
Keep SIMVACOR in a cool dry place where the temperature stays below 25°C.
Do not store it or any other medicine in the bathroom or near a sink.
Do not leave it in the car or on window sills.
Heat and dampness can destroy some medicines.
Keep it where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.
If your doctor tells you to stop taking SIMVACOR or the tablets have passed their expiry date, ask your pharmacist what to do with any that are left over.
- SIMVACOR 10, 10 mg: Light pink coloured, oval, biconvex film-coated tablets, marked ‘SVN 10’ on one side and ‘NEO’ on the other side.
- SIMVACOR 20, 20 mg: Tan coloured, oval, biconvex film-coated tablets, marked with ‘SVN 20’ on one side and ‘NEO’ on the other side.
- SIMVACOR 40, 40 mg: Pink coloured, oval, biconvex film coated tablets, marked ‘SVN’ 40 on one side and ‘NEO’ on the other side.
- SIMVACOR 80, 80 mg: Pink coloured, oval, biconvex film coated tablets marked with ‘SVN 80’ on one side and ‘NEO’ on the other side.
SIMVACOR tablets are available in blister & bottle packs.
Other ingredients (excipients)
- Butylated hydroxyanisole
- Ascorbic acid
- Citric acid monohydrate
- Cellulose - microcrystalline
- Starch - pregelatinised maize
- Magnesium stearate
- Hypromellose - 15
- Hydroxypropyl cellulose
- Titanium dioxide E171
Each tablet may also contain one or all of the following: iron oxide red E172, iron oxide black E172, iron oxide yellow E172.
Cipla Australia Pty Ltd
Level 1 / 132-136 Albert Rd
Unit 5/36 Campbell Ave
CROMER NSW 2099
Australian Register Numbers
10 mg - AUST R 182910
20 mg - AUST R 182911
40 mg - AUST R 182912
80 mg - AUST R 182913
10 mg - AUST R 182906
20 mg - AUST R 182907
40 mg - AUST R 182908
80 mg - AUST R 182909
This leaflet was prepared in April 2013.